Chapters still urge Medicaid expansion

NASW chapters continue to pressure state lawmakers about the need to adopt the Affordable Care Act’s Medicaid expansion provision.

At press time, 26 states and the District of Columbia are implementing ACA’s Medicaid expansion, which opens Medicaid services to millions of people by expanding eligibility to adults under age 65 with incomes at or below 138 percent of the federal poverty level.

A U.S. Supreme Court decision in 2012 allowed states the option to implement the expansion.

Three states have so far adopted a hybrid model. Arkansas, Iowa and Michigan have received Medicaid expansion “Section 1115 waivers,” which provide federal matching funds while giving states flexibility in the way the programs are implemented.

States with approved waivers are enrolling some or all of their newly eligible Medicaid beneficiaries in private coverage offered through the health insurance marketplace, and they are charging some beneficiaries modest premiums. Indiana, New Hampshire and Pennsylvania have submitted waiver applications to the Centers for Medicare and Medicaid Services.

On the flip side, some state lawmakers have rejected the Medicaid expansion — and the promise of significant federal funding — as a political statement. However, even conservative states are slowly warming up to the idea of the private coverage option, said Carla Damron, executive director of the NASW South Carolina Chapter.

Lawmakers in South Carolina oppose the expansion, but are keeping a sharp eye on the progress other conservative states have made in debating a compromise.

“Other Republican governors are embracing the Medicaid expansion through a private option and they are getting positive press through this,” she said.

The chapter has made Medicaid expansion its top legislative priority and is an active member of the Close the GapSC coalition. Its key message maintains that adopting Medicaid expansion would open up federal funds to assist about 300,000 state residents who would qualify.

With a busy election year, the chapter’s Political Action for Candidate Endorsement is also active in supporting candidates who embrace Medicaid expansion.

“We are also working on expanding the coalition by increasing the number of chambers of commerce on board and we’re working on our messaging,” said Damron, who is a member of the coalition’s steering committee.

Texas is another conservative state that has so far declined to implement the Medicaid expansion.

The state’s NASW chapter is working to help change that, said Will Francis, the chapter’s government relations director.

Besides being an active member of the coalition Cover Texas Now, Francis testified at a state hearing in August about why NASW-Texas believes that expanding Medicaid is the best choice.

Texans are uninsured at a rate of 1.5 to 2 times the national average, and there are 1 million state residents who would be eligible for coverage if Medicaid were expanded, Francis said.

“If Texas were to do nothing, by 2022 we could experience a net loss of $9.2 billion in federal tax revenues without gaining any benefits,” he said.

It appears Texas is leaning in a direction similar to the Medicaid expansion waiver states, he added.

With that in consideration, he said the chapter is “actively encouraging our state legislature to either accept expansion or to find an alternative solution that provides hard-working but still needy Texans with the coverage they need to thrive.”

‘Bridging the Gap’: New health care technology important for promoting continuity of care

One way to improve the health care needs of vulnerable populations is by addressing their lack of access to medical information technology.

Mel Wilson, manager of the NASW Department of Social Justice and Human Rights, attended the September meeting “Bridging the Gap: Improving the Health of Justice Involved Individuals through Information Technology.”

The event was hosted in part by the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment.

With the expansion of Medicaid benefits to low-income single adults, there is increased access to health care for persons who would have been uninsured before the passage of the Affordable Care Act.

This has meant that vulnerable and historically marginalized populations — such as those involved with the justice system, the homeless and young adults “aging out” of the foster care system — will be covered to receive comprehensive health and behavioral health treatment in states that have approved Medicaid expansion.

The “Bridging the Gap” conference brought together state, federal and private-sector stakeholders to discuss the importance of ensuring that new health care technologies, like electronic medical records, are implemented in correctional facilities — especially local jails — that will promote continuity of care once a person is transitioned back to his or her community, Wilson said.

Creating connectivity through health information technology could help close the gap between continuity of care for people transitioning from correctional settings and for homeless people that are frequently incarcerated in jails for mental health-related reasons, he said.

Wilson added that the potential benefits of creating such systems include improved medical outcomes, reduced number of severely mentally ill patients that are incarcerated in jails, greater treatment efficiency, improved coordinated care, health care cost savings to communities, and increased public safety.